Provider Demographics
NPI:1215024013
Name:CASAVANT, DENISE MCDONALD (LCSW)
Entity Type:Individual
Prefix:MS
First Name:DENISE
Middle Name:MCDONALD
Last Name:CASAVANT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:493 HERITAGE RD
Mailing Address - Street 2:SUITE 3C
Mailing Address - City:SOUTHBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06488-3879
Mailing Address - Country:US
Mailing Address - Phone:203-512-2229
Mailing Address - Fax:203-262-1585
Practice Address - Street 1:493 HERITAGE RD
Practice Address - Street 2:SUITE 3C
Practice Address - City:SOUTHBURY
Practice Address - State:CT
Practice Address - Zip Code:06488-3879
Practice Address - Country:US
Practice Address - Phone:203-512-2229
Practice Address - Fax:203-262-1585
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2013-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0056971041C0700X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT800003623Medicare ID - Type Unspecified